Contribution of Low CD4 Cell Counts and High Human Immunodeficiency Virus (HIV) Viral Load to the Efficacy of Preferred First-Line Antiretroviral Regimens for Treating HIV Infection: A Systematic Review and Meta-Analysis

Our systematic review showed that low CD4 count (<= 200/mu L) and high human immunodeficiency virus viral load (>100 000/mL) increase the risk of treatment failure at 48 weeks (odds ratio, 1.94 and 1.75, respectively). This effect was observed at 96 weeks and across all preferred regimens. We assessed whether low CD4 count and high viral load (VL) affect the response to currently preferred ART. We performed a systematic review of randomized, controlled clinical trials that analyzed preferred first-line ART and a subgroup analysis by CD4 count (<= or >200 CD4/mu L) or VL (<= or >100 000 copies/mL). We computed the odds ratio (OR) of treatment failure (TF) for each subgroup and individual treatment arm. Patients with <= 200 CD4 cells or VL >= 100 000 copies/mL showed an increased likelihood of TF at 48 weeks: OR, 1.94; 95% confidence interval (CI): 1.45-2.61 and OR, 1.75; 95% CI: 1.30-2.35, respectively. A similar increase in the risk of TF was observed at 96 weeks. There was no significant heterogeneity regarding integrase strand transfer inhibitor or nucleoside reverse transcriptase inhibitor backbone. Our results show that CD4 <200 cells/mu L and VL >= 100,000 copies/mL impair ART efficacy in all preferred regimens.